Resumo As vacinas têm grande influência na saúde pública por sua efetividade e relação custo-benefício favorável. Entretanto, com o surgimento de novos imunizantes indisponíveis na rede pública, torna-se necessário discutir o acesso da sociedade em geral. O objetivo deste trabalho foi identificar o significado da vacinação para profissionais e população, assim como abordar a questão do acesso à imunização fora da rede pública de saúde, enfatizando a vulnerabilidade social. Foram entrevistados médicos e cidadãos leigos, e os dados foram analisados a partir de metodologia qualitativa exploratória e do discurso do sujeito coletivo. O sistema vacinal brasileiro foi entendido pelos entrevistados como bom de maneira geral, sendo as principais críticas voltadas à falta de informações e insumos. Quanto ao acesso, os dados sugerem correlação com fatores econômicos, abrindo espaço para discussões bioéticas sobre a vulnerabilidade social da maior parte da população, que não tem condições de pagar por essas imunizações.
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PURPOSE: To compare the efcacy between SO and salicylic acid SA in the treatment of plantar keratosis of diabetic patients. METHODS: Randomized, double-blind clinical trial, with 47 type 2 diabetic patients, both sexes and with plantar keratosis. Patients were randomized into 2 groups: G1 (n = 48; treated with 15% SO extract) and G2 (n = 46; treated with 10% AS). The feet were photographed before (D0) and after the treatment (D30) and keratosis areas were measured using the Image J software. For each patient, a lesion in each foot was analyzed. The results were expressed by median. In the statistical analysis, the Wilcoxin test was used to compare the lesion areas before and after treatments and the Mann-Whitney test was used to compare the regression of the lesion areas between the two groups. P <0.05 was adopted. RESULTS: G1 (D0 = 2 8.156 vs D30 = 2.226; p <0.0001) and G2 (D0 = 4.835 vs D30 = 2.059; p <0.0001) showed a difference between the areas (cm ) of the keratosis, 2 before and after the treatment. There was a difference in the regression of the areas (cm ) of keratosis, between G1 and G2, respectively (4.540 vs 1.171, p <0.0001). CONCLUSION: Symphytum ofcinale proved to be more effective than Salicylic Acid in the treatment of plantar keratosis in diabetic patients.
An 84-year-old man with cardiomyopathy and a pacemaker was admitted to our hospital due to a focal impaired awareness seizure. Computed tomography (CT) scan on admittance evidenced right parieto-occipital hypodensity with mild mass effect. A non-contrast CT scan realized in an outer institution seven months earlier showed that such hypodensity, considered then as a stroke, was present, but slowly progressing. He was submitted to therapy with phenytoin upon entry and his electroencephalogram showed increased slow-wave activity. Cerebrospinal fluid showed hyperproteinrachia, normal cell count and slightly reduced glycorrhachia. With such findings, the main hypothesis of neoplasm and neuroinfection emerged. Magnetic resonance imaging (MRI) could not be realized at first due to his pacemaker. Empiric treatment with acyclovir was initiated but, in spite of that, he maintained somnolence and left hemiparesis. The cardiology team was activated, and his pacemaker was set to do an MRI. His scan evidenced a T2/FLAIR hyperintense mass lesion on the right parieto-occipital area. SWI sequences showed microbleeds along the cerebral cortex and chronic lobar hematoma simulating cortical superficial siderosis. Hence, Cerebral Amyloid AngiopathyRelated Inflammation (CAA-ri) was diagnosed and pulse therapy with methylprednisolone was indicated. By closure of this report, he was started on antibiotics for urinary tract infection, and would be initiated on corticosteroids after 48 hours. CAA-ri is a rare yet reversible etiology of seizures, encephalopathy and focal neurological signs in patients with amyloid angiopathy, an entity that occurs mainly in the elderly as a deposit of amyloid protein on vessel walls. MRI is essential as it shows characteristic cortical-subcortical hemorrhagic lesions. Suggestive findings allows treatment with corticosteroids, optimizing neurological recovery and minimizing future deficits.
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